Bevin proposes major changes to Medicaid, including monthly premiums

Gov. Matt Bevin unveiled details Wednesday of his plan to overhaul Medicaid in Kentucky, saying it will impose monthly premiums of $1 to $15 and save taxpayers $2.2 billion over the next five years.

Bevin said his plan, which would cover all non-disabled adults receiving Medicaid, focuses on creating better health outcomes and personal responsibility for participants, and sustainability for the costly health insurance program that serves low-income and disabled individuals.

The monthly premiums would be based on income levels and would be for “able-bodied adults.” Pregnant women and children would not be charged premiums.

The premiums will encourage participants to “take ownership” of their health care, Bevin said, noting that the plan offers the opportunity to earn credits that can be used to purchase additional benefits, such as dental and vision insurance.

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Credits could be obtained by such acts as volunteer work in health facilities and taking a health risk survey.

“We are robbing too many people of the dignity to do for themselves,” he said. “We owe them better than that.”

At a Capitol news conference, Bevin said the plan, Kentucky HEALTH (Helping to Engage and Achieve Long Term Health) will be presented as a request to the federal government in the form of a waiver application to replace the state’s expanded Medicaid program started by former Gov. Steve Beshear.

Beshear expanded the program’s eligibility requirements by executive order. It resulted in 440,000 people getting health insurance and reducing the state’s uninsured population from 20 percent to 7.5 percent.

Bevin said Medicaid expansion in the state will end if the federal government does not accept his plan. That would mean 440,000 of the 1.32 million Kentuckians on Medicaid would lose eligibility.

The governor said he is confident and hopeful the waiver will be granted by Sept. 30 but that he has “no crystal ball.”

Ben Wakana, press secretary at the U.S. Department of Health and Human Services, said Wednesday that the agency is “hopeful that Kentucky will ultimately choose to build on its historic improvements in health coverage and health care, rather than go backwards.”

Once Kentucky’s waiver has been submitted to the agency, it will be evaluated “based on our longstanding principles of access to coverage and affordability of care, principles that we have repeatedly shared with the state.”

Bevin and his aides said the $2.2 billion in savings in federal and state tax dollars would come from projections that Medicaid would cover fewer Kentuckians — 17,833 in 2017 and 85,916 in 2021.

Left unchanged, expanded Medicaid is expected to cost Kentucky taxpayers an extra $1.2 billion for fiscal years 2017 through 2021.

Bevin’s plan for Medicaid users would be similar to that for state workers. It would include insurance for mental health but not for dental and vision. It would not pay for non-emergency medical transportation.

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Under the Bevin plan, the state could stop Medicaid coverage for those who don’t pay their premium. He called it a “lock-out” provision, which would require users to meet certain conditions before being allowed back into the program.

The plan does not include any co-payments for services.

The Republican governor said traditional Medicaid is designed specifically for the disabled and other vulnerable populations, but Kentucky HEALTH is aimed at encouraging individuals to be independent and preparing them to transition to employer-based coverage or other private insurance. The plan requires Medicaid recipients to use their employers’ insurance coverage within a year.

Adding premiums to the Medicaid program concerns public health advocate Sheila Schuster, who said after the news conference that when out-of-pocket expenses are increased for Medicaid users, they drop out of the program.

“Gov. Matt Bevin declared war on Kentucky’s working families today by announcing his intentions to take away health benefits, increase costs and institute unwieldy requirements for those families to keep health coverage,” the group said in a statement. “And if the federal government refuses to accept these draconian changes, he threatened to kick hundreds of thousands of working Kentuckians off of health care.”

Beshear’s group said Bevin “seems woefully unaware of what Kentuckians on expanded Medicaid — and that’s construction workers, substitute teachers, nurses’ aides, farmers, our neighbors, friends and family — do every day to support their families while still being able to take their children to the doctor.”

Although Bevin said it will be the federal government that decides whether expanded Medicaid stays in Kentucky, Beshear’s group said “it is up to Gov. Bevin himself to decide whether to terminate expansion, not the federal government — and the accountability for that decision will lie on his shoulders.”

Bevin said Wednesday marked the beginning of a 30-day public comment period on the plan.

“In addition to the input we have already received from Medicaid providers, advocates, consumers and other stakeholders, we encourage Kentuckians to take advantage of the many different avenues and opportunities to provide thoughtful responses regarding the proposal we are presenting,” he said.

Bevin thanked Mark Birdwhistell, University of Kentucky HealthCare’s vice president for administration and external affairs, for heading up his administration’s waiver process.

Kentucky House Speaker Greg Stumbo, D-Prestonsburg, said two House legislative panels — the Budget Review Subcommittee on Human Resources and Task Force on Vulnerable Kentuckians — will analyze the proposed waiver and determine its effects on Kentuckians.

Julia Crigler, state director of the conservative political group Americans for Prosperity, applauded Bevin’s effort to “give Medicaid patients skin in the game” and said “no amount of reforms can make Obamacare’s Medicaid expansion financially sustainable.”

Crigler, whose group received funding from the businessmen brothers David H. Koch and Charles Koch, said she was appreciative that Bevin “is willing to pull the plug if the waiver is not granted.”

U.S. Sen. Mitch McConnell, R-Louisville, praised Bevin “for recognizing the unaffordable mess left behind by his predecessor and responding with innovative, common-sense steps to engage patients, improve health and reduce the burden on Kentucky taxpayers.”

A complete draft of the Kentucky HEALTH waiver proposal is available for public review online at http://chfs.ky.gov/kentuckyhealth or for in-person inspection at the Cabinet for Health and Family Services, Office of the Secretary, 275 E. Main St. in Frankfort.